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Research Review: "Survey of Injuries in Seattle Area Levels 4 to 10 Female Club Gymnasts."

The last several weeks have been quite a whirlwind in the USA Gymnastics community with the National Team losing several members before Worlds yet ultimately pulling through with a Gold medal.  While the injuries to the likes of Sacramone, Memmel, Bross, Caquatto, and Li have focused attention on health and safety of our elites, the grass roots level (which all elites must pass through) has its own share of injury issues.  Fortunately, the lower levels have not eluded the eye of the research community. 

O'Kane, et al (2011) recently studied a sample of ninety six gymnasts in Levels 4 through 10 from five randomly selected gyms in the Seattle area.  Below is a summary of their findings with our thoughts on those findings.

"Acute injury rate was 3.6 fold greater among 10 to 12 year olds and 3.1 greater among 13 to 17 year olds compared to 7 to 9 year olds."

***This result makes intuitive sense: older gymnasts have more mileage on their bodies, train more hours, and attempt more difficult skills.  

"Gymnasts are at similar risk of acute and overuse injuries, and acute injuries were greater among older gymnasts. "

***We must be careful with injuries defined as “acute.”  It’s easy to fall into the trap of seeing acute injuries as isolated events.  While this designation may be technically correct for medical records purposes, “acute” injuries are often the culmination of a long period of overuse or misuse.  Identifying the underlying movement dysfunction is critical to prevent both acute and overuse injuries. 

"The most commonly acutely injured body parts were foot (21.0%) ankle (19.3%), knee (14.0%), and wrist (8.8%)."  

***Most injuries occur when colliding with the ground, not while going up.  Landing skills are often neglected at all levels in the rush to learn new routines.  Because the data indicates a higher acute injury rate among older gymnasts, one interpretation is that younger gymnasts can get away with poor landing skills at lower levels, but landing skill deficits inevitably catch up with gymnasts as they progress up the ranks.

"Most injuries occurred on floor exercise (32.1 %), beam (20.7%), and bars (17.0%)."

***A couple of possible reasons why most injuries occurred on floor exercise: First, floor has the most landings with the highest vertical displacement.  Second, floor requires the most cardiovascular conditioning, which highlights the possible role of fatigue in contributing to form deterioration.

“During their gymnastics careers, concussions occurred in 30.2% and stress fractures affecting mostly low back and foot occurred in 16.7% of the gymnasts.”

***With the greater push for concussion awareness in all sports, including gymnastics, it is not surprising that concussions were the most commonly diagnosed injury.  Stress fractures tend to be under-diagnosed as many stress fractures are asymptomatic.  X-rays won’t detect most stress fractures; only the worst symptomatic cases are referred for nuclear imaging (bone scans).  The 16.7% stress fracture rate is likely a low estimate.     

"Gymnastics injury prevention studies should focus on older gymnasts, concussion education, and landing after a skill."

***Not sure I fully agree with limiting the focus to older gymnasts, although practical considerations may necessitate this limitation.  The roots of injury can take hold at a young age.  It would be instructive for future research formally review movement dysfunction in the lower levels and identify key links to injuries in the later years.   

References

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